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Asthma Care Training (ACT) for Kids

A program of the Asthma and Allergy Foundation of America, implemented in Providence 'Alaska' Medical Center, Anchorage, Alaska.

Asthma Care Training for Kids: Program Components

The ACT for Kids program was validated in 1984 and updated in both 1994 and 1997 to adhere to the National Asthma Education and Prevention Program (NAEPP) Guidelines for the Diagnosis and Management of Asthma. Upon validation of ACT for Kids, the Asthma and Allergy Foundation of America (AAFA) acquired the distribution rights for the program. The copyright for ACT is held by its creators in the Department of Medicine and Pediatrics and the Department of Allergy and Clinical Immunology at the University of California at Los Angeles School of Medicine. AAFA worked closely with the creators to develop a package of materials that would be made available to others who may be interested in implementing the program in their clinical setting. The package contains:

A program curriculum that includes:

the intervention protocol;

a master copy of the activity books (described in detail in the following section);

three instructor manuals-one each for the child’s instructor, parent’s instructor, and physician or pharmacist.

An instructor kit that includes the following reusable materials:

three body maps (described in detail in the following section);

a relaxation tape;

two sets of alphabet aggravators’ panels (described in detail in the following section), one set of 24 cards for the child’s instructor without words on front, and one set of 24 for parent’s instructor with words on front;

two sets of environmental panels, each set containing 10 cards showing everyday situations in which one could be exposed to asthma triggers;

An asthma symptoms body map-An 11-inch drawing of a body that represents the child’s body. The map is accompanied by colorful stickers depicting different symptoms that occur either before or during the early stages of an asthma attack (such as coughing, sneezing, ear pain, sore throat, shakiness, and chest pain). Children place the stickers on the map to indicate what they are feeling. During their session, the parents place the stickers on the map to indicate their perceptions of what the child is feeling. Children and parents compare the maps when they reconvene to see whether parents are aware of the range of symptoms their children experience.

Drawing of a cross section of airways-The purpose of this exercise is to teach children about the medical nature of their disease. This is accomplished by using three different drawings of an airway that display the mucus membranes and surrounding smooth muscle to demonstrate the different physiological changes that occur during an asthma attack. In one of the drawings, the airway is open. In the second drawing, the airway is starting to close, and in the third drawing, the muscles in the airway are fully constricted and the mucus membranes are open and full. Participants color-code the three drawings-green for go, yellow for caution, and red for stop.

Peak flow meter do’s and don’ts-Instructions on how to get the best results when using peak flow meters.

Peak flow aggravator detective sheet-A sheet for recording peak flow readings. If the number is in the yellow or red zone, the sheet asks the child to be a detective and to try to identify the triggers and/or early warning signs.

Family decision-making styles-Worksheet that allows the child to analyze his or her family’s decision-making style and its effect on the child’s asthma management.

Program Lessons

Educational lessons emphasize the role of the child as an active participant in preventing and controlling symptoms. The child is encouraged to recognize initial symptoms and know the appropriate actions to take for the management plan to be effective. Parents are encouraged in their nurturing skills and advised on creating a home environment where children can practice decision making in caring for themselves.

Although the research intervention used five 1-hour sessions to present the information, AAFA, in collaboration with UCLA, updated the lessons in 1997 to adhere to the Guidelines for the Diagnosis and Management of Asthma. The fourth and fifth lessons were integrated into the revised first and second lessons to form a total of three sessions. The following is a description of each of the lessons.

Lesson 1: Warning Signals-What Is Asthma, and How Does It Affects My BodyParents and children identify asthma symptoms and discuss the similarities and differences in the children’s asthma symptoms and their progression. Children also discuss ways to communicate their symptoms to parents, physicians, and teachers. In addition to personal body maps created by children, parents and children also construct a group body map that allows them to compare symptoms identified by child and parent and to identify the severity of symptoms by a color code.

Lesson 2: Roadblocks-Why I Have Asthma and What Sets It OffChildren and parents learn to identify environmental triggers. They also discuss the similarities and differences in the children’s triggers. In addition, parents and children identify ways to avoid personal triggers. The asthma aggravators alphabet cards and the environmental walk around panels are used.

Lesson 3: Tune Ups-What to Do and When to Do ItChildren and parents learn breathing and relaxation exercises and discuss the appropriate use of medications. Children also discuss ways to remember to take preventive measures. The last hour of this session is spent in one-on-one consultation with the physician to review medication.